A Caffeine-Containing Post

In follow up to an ER visit for a new onset migraine headache, my patient casually asks if caffeine could be playing a part in his headache and blood pressure issue. As we reflected on that possibility he admitted to drinking at least 64 ounces of diet, caffeine-containing sodas daily. WHAT?!?!? Not only can caffeine raise both blood pressure and pulse but if one already has hypertension, caffeine may elevate it even more than in a normal person.[1] When he presented to the ER with an excruciating headache and extremely high blood pressure he underwent a head CT scan that was normal and it was theorized that the blood pressure was due to the headache, perhaps a migraine. The problem I had with the diagnosis is that people do not typically present with their first migraine headache in their mid-40s. The ER started him back on blood pressure medication (he had been able to stop it about a year ago with diet and exercise) and sent him back to me for followup. So in my office we began to explore the biggest question: was the pressure causing the headache or the pain from the headache causing the blood pressure? In the time between the ER and our office visit he realized that he got a headache if he went a few hours without caffeine. We developed a plan for slowly stopping all caffeine products before ordering any more expensive tests. Since his pressure was still elevated, his blood pressure medication was increased.

Over the course of a month he brought his exercise level back to 2012 levels (before he let work take over his schedule) . He reduced and came off the caffeine with the exception of one cup of green tea in the morning. He took the bigger medication dose just one day but it made him dizzy. Soon he found the 1/2 dose too much. By the time I saw him one month later his weight was down, his blood pressure was normal and he was completely off medication.

Moral of the story? First of all, caffeine can be beneficial[2] as can working hard. However–all things in moderation. Secondly, what you put in your mouth (or don’t) and how much you exercise you do can sometimes work as well as a pill. And there are no side effects!